Our sweet enemies: The Price for affluence and urbanization

Poor countries are now getting richer than before. But they are also paying the price of affluence and urbanization: the rise of chronic diseases.

As you read this, nearly 12.1 million people living in Sub-Saharan Africa are struggling with diabetes, with only 15 percent of them diagnosed. Project Hope, a nonprofit organization, estimated that by the year 2030, 23.9 million adults in Sub-Saharan Africa will have diabetes.¹ Broadly speaking chronic diseases, which includes diabetes, cardiovascular disease, cancer and chronic respiratory diseases, now looms as the pre-eminent public health menace in poor countries. In Sub-Saharan Africa, for example, it is the number one cause of deaths of adults over the age of 30.²

There used to be a time when people in poor countries were too hungry and hardworking to be obese. During that time, only a few people could afford cigarettes and candies, and carbonated drinks such as Pepsi and Coca-Cola were luxuries. Also people in poor countries mostly died before the diseases of ripe middle age kicked in. The general belief then was that non-communicable diseases were a rich-world problem. A lot of things have changed since then. The standards of living in developing countries, particularly African countries, have improved significantly. However, the citizens of these countries are now paying stiff price for this improved living conditions. Today, developing countries bear more than 80 percent of the burden of chronic diseases. Available published evidence indicates that their share of these diseases will continue to grow. This will obviously add more burden to the one they already have – the vagaries of infectious diseases. In countries like India, for example, 40 percent of children under five are malnourished.³ Yet obesity is an acute health problem in that country.

Taking a bite out of progress.

Old and new diseases can be a lethal combination. For instance, those that suffer from diabetes are three times more likely to contract tuberculosis. One type of cancer that is common in equatorial Africa, namely, Burkitt’s lymphoma, is linked to malaria. HIV patients normally receive anti-retroviral treatments. However, this treatment increases their risk of developing diabetes and cancer.

According to the world Health Organization (WHO) deaths from non-communicable diseases will rise by 15 percent between 2010 and 2020. At least 20 percent of this jump value will come from Africa and Asia. In countries like China, the number of diabetics is expected to double by 2025. By the year 2030, chronic illnesses are likely to surpass maternal, child, and infectious diseases as the biggest killer in Sub-Saharan Africa.⁴ Most of these chronic illnesses stem from sedentary lifestyles, sugar, fat and smoke. But they also include diseases that are not caused by any of these factors, such as sickle cell – a blood disorder that kills many African children.

The affected regions in poor countries are woefully unprepared for this development. Their health-care systems, which usually receive funds and medicines from foreign donors, are designed for acute problems. So naturally, less than 3 percent of aid for health in these countries goes to chronic illnesses. And due to poverty, or even a lack of health insurance, many patients tend to delay treatments until it is too late. It is a good thing that many of the drugs donated to these countries are no longer covered by patents, which means that they are supposed to be cheap. However, they are still costly and scarce due to tariffs, poor distribution and high mark-ups. The health authorities are also stretched thin by high demand for their services. A child’s life can be saved for life by the right inoculation. In contrast, chronic diseases may require lifelong medicine and treatments. Like every educated person knows, a big cause of diabetes is unhealthy diet. But then, that makes it more complicated because eating right can be a battle involving brain chemistry and food industry practice. This explains why rich countries are also losing the battle for diabetes.

Not by meeting alone

So far the world’s response has been to have meetings, such as the United Nations summit held in New York in September of 2011. Prior to that, the only summit devoted to health was on HIV and was held in 2001. The summit was motivated by a sense of urgency about the scourge of AIDS.⁵ The outcome, however, was a positive one since it brought about a decade of dramatic progress in managing the AIDS crisis. Unfortunately, for some reasons, non-communicable diseases such as heart disease does not arouse the same passion or urgency. So it was not a surprise that while the countries that attended UN summit in 2011 passed a  political declaration on chronic diseases, they could not agree on targets for reducing them.

With no clear global lead, the affected countries has continued to struggle. In some places like in Kampala (Ugandan capital), most of the healthcare organizations spends a significant proportion of their funds on drugs and staff training. But since money is scarce in that area, health service delivery is inefficient. For instance, getting results from a procedure such as a biopsy can take up to one month if the patient lives outside Kampala.

It is worth bearing in mind that taking simple steps like offering inexpensive drugs, reducing salts in foods and raising tobacco tax can make a big difference here. Raising tobacco tax is particularly important, for two reasons. First, it is the best way for curbing cancer and the diseases of the heart and lungs. Second, it can be a good method for raising money for health care. Using tobacco tax can, however, be a challenge in poor countries. They provide the scarce jobs needed by the masses and revenues needed by the government. So in a country like Uganda, it may be hard to scare the industry away with high taxes.

Using some of the infrastructures and arrangements that are already in place for treating HIV conditions can also be a good strategies for many of these poor countries. For instance, in Western Kenya, the AMPATH program was originally designed to treat only HIV patients. But now that HIV infection is no longer a death sentence, the programs areas of coverage have been extended to cover those with such illnesses as cancer and diabetes.⁶ Its workers conducts a door-to-door screening program where the check the HIV status as well as the blood pressure and blood sugar  of their patients. A similar program initiated by  the United States, known as the President’s Emergency Plan for AIDS Relief(PEPFAR), also conduct regular health screening programs that has the goal of fighting HIV  by boosting broader health care.⁷

If the experience of the past ten years teaches us anything, it is that when it comes to fighting chronic diseases in poor countries, the most sustainable efforts will be those that provide healthcare and make money. Take Eli Lilly, the American pharmaceutical giant as a good example. The company provides free insulin to AMPATH in Kenya. The company regularly tests models for the treatment of chronic ailments like diabetes in countries such as Brazil, India and South Africa. But Eli Lilly, like every other corporate organization, also has profit motive. So while proving help for these poor countries now, Eli Lily knows that profits will follow later. Novo Nordisk, the world’s biggest insulin manufacturer, is another company that is making reasonable progress in fighting chronic diseases in poor countries. In China, the country controls almost 63 percent of insulin market as of September 2011.⁸ That represents a significant profit. Now it want to replicate the program in poor countries like Vietnam, Malaysia and Indonesia.

Given the large size of the population of poor countries, chronic diseases is obviously a huge market – but with lots of pain for the poor masses. Unfortunately, this market is growing in alarming proportions.

References

¹Project Hope (2011): Chronic Disease in South Africa. Retrieved February 20, 2015 from http://www.projecthope.org/news-blogs/africa-blog/2011/chronic-disease-in-south.html

²Ouyang H. (2014): Africa’s Top Health Challenge: Cardiovascular Disease. The Atlantic. Retrieved February 20, 2015 from http://www.theatlantic.com/health/archive/2014/10/africas-top-health-challenge-cardiovascular-disease/381699/

³Chronic Diseases in Developing Countries. (2011, September 24). The Economist. Retrieved February 20, 2015 from http://www.economist.com/node/21530099

⁴Ibid

⁵Ibid

⁶Strother R.M., et al (2013): AMPATH-Oncology: A Model for Comprehensive Cancer Care in Sub-Saharan Africa. Journal of Cancer Policy, 1(3-4), e42-e48.

⁷Chronic Diseases in Developing Countries. (2011, September 24). The Economist. Retrieved February 20, 2015 from http://www.economist.com/node/21530099

⁸Ibid